Which beta-blocker should be used for the prevention of postoperative atrial fibrillation in cardiac surgery? A multi-treatment benefit-risk meta-analysis

Abstract Background This meta-analysis was conducted to evaluate the impact of perioperative use of beta-blocker (BB) on postoperative atrial fibrillation (POAF) after cardiac surgery other than isolated coronary artery bypass grafting (CABG). Methods Five online databases were searched. Studies were included if they (1) enrolled patients who underwent cardiac surgery other than isolated CABG and (2) demonstrated the impact of perioperative use of BB on POAF based on the randomized controlled trial or adjusted analysis. The primary outcome was the occurrence rates of POAF after cardiac surgery. A meta-regression and subgroup analysis were performed according to the proportion of patients with cardiac surgery other than isolated CABG and the timing of BB use, respectively. Results Thirteen articles (5 randomized and 8 nonrandomized studies: n = 25,496) were selected. Proportion of enrolled patients undergoing cardiac surgery other than isolated CABG ranged from 7 to 100%. The BBs were used in preoperative, postoperative, and both periods in 5, 5, and 3 studies, respectively. The pooled analyses showed that the risk of POAF was significantly lower in patients with perioperative BB than those without (odds ratio, 95% confidence interval = 0.56, 0.35–0.91 and 0.70, 0.55–0.91 in randomized and nonrandomized studies, respectively). The risk of POAF was lower in the BB group irrespective of the proportion of nonisolated CABG. Benefit regarding in-hospital mortality was inconclusive. Perioperative stroke and length of stay were not significantly different between BB and non-BB groups. Conclusions Perioperative use of BB is effective in preventing POAF even in patients undergoing cardiac surgery other than isolated CABG, although it did not translate into improved clinical outcomes.

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Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1667065 ◽

2018 ◽

Vol 67 (02) ◽

pp. 107-116 ◽

Cited By ~ 5

Author(s):

Kennosuke Yamashita ◽

Nan Hu ◽

Ravi Ranjan ◽

Craig Selzman ◽

Derek Dosdall

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cardiac Surgery ◽

Meta Analysis ◽

Postoperative Atrial Fibrillation ◽

Clinical Risk Factors ◽

Systemic Review ◽

Left Ventricular Ejection ◽

Clinical Risk

Background Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF. Methods A systematic search of PubMed, MEDLINE, and EMBASE databases was performed. Results Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47–0.63), left atrial diameter (0.45: 0.15–0.75), and left ventricular ejection fraction (0.30: 0.14–0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31–1.96), chronic obstructive pulmonary disease (1.36: 1.13–1.64), hypertension (1.29: 1.12–1.48), and myocardial infarction (1.18: 1.05–1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00–1.13). Conclusion The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.

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